SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown 2193, Johannesburg, South Africa E-mail:
DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
J Water Health. 2020 Oct;18(5):798-819. doi: 10.2166/wh.2020.085.
Interventions to reduce undernutrition and improve child growth have incorporated improved water, sanitation, and hygiene (WASH) as part of disease transmission prevention strategies. Knowledge gaps still exist, namely, when and which WASH factors are determinants for growth faltering, and when WASH interventions are most effective at improving growth. This study drew cross-sectional data from a longitudinal cohort study and used hierarchical regression analyses to assess associations between WASH factors: water index, sanitation, hygiene index, and growth: height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ) at 1, 6, and 12 months postpartum among infants a priori born healthy in Soweto, Johannesburg. Household access to sanitation facilities that were not safely managed was associated with a decrease in HAZ scores at 1 month (β = -2.24) and 6 months (β = -0.96); a decrease in WAZ at 1 month (β = -1.21), 6 months (β = -1.57), and 12 months (β = -1.92); and finally, with WHZ scores at 12 months (β = -1.94). Counterintuitively, poorer scores on the hygiene index were associated with an increase at 1 month for both HAZ (β = 0.53) and WAZ (β = 0.44). Provision of safely managed sanitation at household and community levels may be required before improvements in growth-related outcomes are obtained.
干预措施旨在减少营养不良并促进儿童生长，已将改善水、环境卫生和个人卫生（WASH）纳入疾病传播预防策略之中。然而，目前仍存在知识空白，例如，在何时以及哪些 WASH 因素是导致生长迟缓的决定因素，以及 WASH 干预措施在何时最能有效促进生长。本研究从一项纵向队列研究中提取了横断面数据，并使用分层回归分析评估了 WASH 因素（水指数、环境卫生、个人卫生指数）与生长（1、6 和 12 个月时的身高别年龄 Z 评分（HAZ）、年龄别体重 Z 评分（WAZ）、体重别身高 Z 评分（WHZ））之间的关联，这些婴儿均在索韦托、约翰内斯堡预先被认定为健康。家庭获得未安全管理的环境卫生设施与 1 个月（β = -2.24）和 6 个月（β = -0.96）时 HAZ 评分下降有关；与 1 个月（β = -1.21）、6 个月（β = -1.57）和 12 个月（β = -1.92）时 WAZ 评分下降有关；以及与 12 个月时 WHZ 评分下降有关（β = -1.94）。具有讽刺意味的是，个人卫生指数较差与 1 个月时 HAZ（β = 0.53）和 WAZ（β = 0.44）评分增加有关。在获得与生长相关的结果改善之前，可能需要在家庭和社区层面提供安全管理的环境卫生设施。
